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Stonlake Skyport Addn-PT250317PERMIT TO WORK ON HIGHWAY RIGHT OF WAY WITHIN THE DALLAS COUNTY AREA COPY OF THIS DOCUMENT MUST BE KEPT ON JOBSITE Permit No.:___________ _____________________________ is giving written notice of proposed work to take place within the right of way of _______________ in _________________ County, TX as follows: (Give general written description of location and work to take place. – Do not write “See Attached”) This work is limited to improvements as specified above and detailed in the attached drawings. If in the opinion of TxDOT, such a installation, construction, modification, or alteration is in conflict with the current highway or planned future highway improvements and could endanger the traveling public using said highway, TxDOT shall have the right, after receipt of such notice, to prescribe such regulations as necessary for the protection of the highway facility and the traveling public using said highway. All work on the highway right of way shall be performed in accordance with TxDOT “Standard Specifications for Construction and Maintenance of Highways, Streets, and Bridges”. Our firm will use best management practices to minimize erosion and sedimentation resulting from the proposed work, and we will revegetate the work area as indicated under “Revegetation Special Provision.” Our firm will insure that traffic control measures complying with applicable portions of the Texas Manual of Uniform Traffic Control Devices will be installed and maintained for the duration of this work (Approval of traffic control plans required by area/maintenance office.) Our firm will assume all risks associated with this work within the TxDOT Right of Way. These risks included, but are not limited to, injuries to our workers, damage to contiguous utility lines that may be in the area, injuries or damage resulting from our failure to follow the approved plans. We will be responsible for any damages or accidents that may occur as a result of our work on highway right of way, and save TxDOT and the State of Texas harmless. Refer to attached location map and drawings for a more specific location a description of work activity. The undersigned representative agrees to comply with the terms and conditions set forth in this notice. This permit will become null and void if the above referenced work is not completed within six (6) months from the issuance date of this permit. The proposed work will begin on the ____________ day of ________________, 20___. The Grantee MUST notify the Dallas County Area Office at (214) 320-6240 at least 48 hours prior to any construction within the TxDOT Right of Way. Owner: _____________________________ Texas Department of Transportation By (Print): ___________________________ Dallas County Area Office Signature: ___________________________ 4777 US Hwy. 80 East Address: ____________________________ Mesquite, Texas 75150 ____________________________ _____________________________ Area Engineer or Maintenance Supervisor Phone: _____________________________ Signature: _____________________________ _____________________________ Date Blake Wilson